Sometimes you can hear a “yelp” even before you enter a room.  You can hear them a few rooms away.  It may be kidney stones, a slipped disc or the gout.  This was the yelping I was ready for when I entered medical school.  Bringing a calm presence to the room so that I can evaluate and develop a plan.  Making sure that patients know we will have a plan to help decrease the acute pain that is providing a “yelp.”

But this is not the yelp that physicians now deal with.  Yelp is a public business founded in 2004 that publishes crowd-sourced reviews about businesses.  This has led to many different companies developing websites where patients can go to document both the good and bad about their physician experiences.  You can go to Health Grades or Vitals and basically write whatever you would like about your experience.

Who uses these apps?  Mostly 2 types of people.  Those that are appreciative of the care or super critical.  It seems that some people as a hobby enjoy pointing out everything that went wrong.  I feel worse for restaurants and hotels, but they are not quite as personal.  If you ever are feeling great about yourself take some time and google your name.  Every displeased patient has put to keyboard your deficiencies.  I use this as a time to fight back.

This is my time to push back on the things that are written about myself and others on the internet.  I am absolutely trying to improve as a physician. And I need constructive criticism but the amount of yelping is getting out of control.  Especially if you use this time to comment on physician’s physical appearance.  Yes.  I realize that since the pandemic started that I have not gotten a haircut.  And yes, I realize that I have a ponytail at this time but that does not affect the care given.  Please stop discussing my hair on the internet. 

Pain medicine.  There are debates about chronic pain medicine.  Currently my office has decided to not treat chronic pain with opiates.  There are pain management doctors that we can help with trying to control chronic pain.  Yet the most common complaint being yelped about is that the doctor allowed me to be in pain.  I first always try to acknowledge the experience pain patients are in and come up with a plan to try and overall reduce pain and functioning.  But it is time to stop yelping about doctors not giving the controlled medicines you ask for.

Wait times.  I get to work early.  Every physician is only one patient away from being behind.  Many patients come in with lists and then wonder why their appointment is not happening right on time.  Just an FYI for patients.  I got here early.  All of you are the reason that then I am running late.  I rarely turn away a patient for being late and it is time to stop posting about how long you waited to see me.

The honest truth is that most patients are writing very nice things on the internet.  But human nature makes us focus on the few negative things written.  I really try not to read all of them but I am human.  I have googled myself and my reviews.  I encourage the rest of you to try your best to avoid reading the reviews sent our way.  Also, I wish my mother and my aunt would stop googling my reviews.  My mom loves to tell me she read about how great my bedside manner is on the internet.  Also she asks me what my plan is to stay on time throughout the day.  After reading the internet my aunt and mother had been discussing ideas on how I could better stay on time.  Thanks yelp.  Thanks for nothing. 

The Doc is In

Life is hard. Daily Obstacles.

Keep Pushing. Even if it feels impossible.

Grin and bear it. Force through.

Hard work. Practice. Must pursue.

Never give up. Keep fighting.

Believe in yourself. Blood spilling. End is frightening.

Body is broken. Stress holding.

Looking for answers. But bowels are slowing.

Always had grit. Perseverance.

Still failing. Blocked sigmoid. Inteference.

Stressed. Stop guessing. Not abstract.

Not cancer. Not death. Bowels will not relax. Need miralax.

Face sweating. Fists tight. Push hard. Success. Elation.

From demons to depression. Not those. Just constipation.

You finish. Release. Destroy the bowl.

Nothing could stop you. Won the war. Against your own butt hole.

Testing – Urine Drug Testing

Physicians often say the hardest thing about medical school was getting in.  I am not sure that I agree but the rest of the experiences do not happen if you do not get in.  How do you get into medical school?  A test score is the main answer.  We all had to take the MCAT.  I remember realizing that many of my friends had taken a full prep course for this test while I had been teaching myself from a work book to take a test that would decide whether or not my life’s dream would come true.  I cannot imagine where my life would be if had not done decent on that test. 

Medical school was all about tests.  We had different systems taught in modules ending with a test.  The first 2 years were more about passing tests than learning for me.  It was biochemistry and physiology and I was still trying to process how this information would help me take care of patients.  Third year of medical school things start to come together.  Each rotation was followed with a test but at least these tests were asking clinical information.  We have Step 1 and then Step 2 and Step 3 and then board certification.  The tests keep coming.

But one has finally been canceled.  The Step 2 Clinical Skills exam has been canceled.  This was the test that cost over 1000 dollars.  It was also only held in 4 cities at the time I was in medical school.  This test consisted of medical students interviewing standardized patients.  I think that this cancellation was a step in the right direction.  Medical schools have the patient interaction/experience added into their curriculums.  This test was a money grab for the boards.  The financial and mental stress that adding this test in was too much for medical students.  From the time it was started many knew this test was wasteful.  All we needed was a pandemic to end it.

It is a new year and we have been updating our controlled substance contracts in my office.  Which means I have been testing my patient’s urine.  This is a test that one cannot study for.  Most patients are taking medicine for the right reasons but the UDS does shed some light on the substance abuse issues that patients are not also forthcoming about.  In medical school there is a plan to focus on certain areas if a particular test is failed.  Tutoring and extra study time.  But what to do if a patient fails a urine drug test.

Do I cut the patient off immediately?  Do we taper down?  I many times have asked the patient if they had issues with substance abuse?  But often times patients do not want to admit.  There was a mistake.  My pills got flushed down the toilet, so I had to take something else.  I promise that I did not take that.  One even wanted to do a lie detector test.  I do not argue about the validity.  This is not meant to be punitive.  I am trying to find ways with these failed tests to see in which ways I can help this patient going forward.  But in a way without prescribing controlled medicines.

Tests are had.  Tests are stressful.  We need to find a way if someone does not do well on a test to help them perform better in the future.  I love seeing patients but still hate discussing their urine drug tests.  I am getting ready to take the Family Medicine Boards again.  At this point in my career I would do well in the Step 2 CS but I am glad it is gone.  Due to the opiate epidemic we need to work together to make sure that urine drug tests that are abnormal can lead to ways to help patients.  Everyone needs to find ways to use this to help improve patients lives.  We can figure this answer out together.  If you do not have the answer right now that is ok.  It is not a test.

The Doc Is In

What having the flu can teach us about nutrition. Everyone has gotten sick. Laying in bed with fevers, chills, and cough. We used to hope that we did not have the flu. Now we say I hope I have the flu and not Covid. Then we ask our loved ones to make us some chicken soup. As an overall theme Americans eat too much and way too many processed foods. Until we get sick. When you get the flu, your immune system goes on overdrive. Our body is working on controlling our temperature and fighting off a cough. At this time you may also have nausea, diarrhea, or headaches. 

All of these symptoms negatively affect appetite. We need to let our gastrointestinal tract rest so that more of our body’s energy can work on releasing cytokines and immune modulators to help us get better. Our bodies conserve energy in digestion by decreasing our appetites. Yet many of the foods/thoughts that we turn to while having the flu could actually help us overall with our daily nutrition. When one gets the flu we turn to chicken broth, we increase our fluids and oatmeal. Leafy green vegetables have likely immune-boosting benefits. 

As opposed to bacon and eggs, sick patients often will have a bowl of yogurt. You want to avoid fatty foods. It would be unlikely for you to get gout or have your gallstones flare while on the flu diet. Also, most people drink less alcohol when they have the flu. More water gets consumed and less vodka. Lots of people want to lose weight and eat healthier. So I am going to propose a new diet fad for the world. The Flu Diet. Yogurt or granola for breakfast. Lots of water and/or low sugar electrolyte drinks during the day. Lots of leafy green vegetables including broccoli or one of those kale smoothies that people are always trying to get me to drink. Low salt chicken soup for dinner. And definitely get your flu shot. But if you really want to lose weight consider eating like you have the flu.

The Doc is In

A virus has spread.

You start to cough. It’s too late.

Your grandma is gone.